When is urine drug testing indicated in safe opioid prescribing?

• A. Always every visit.
• B. Never needed.
• C. Only at discharge.
• D. When indicated based on risk factors or concern for misuse.

Answer: (D)

Urine drug testing is a targeted safety tool in opioid therapy, used to confirm that a patient is taking prescribed medications as directed and to detect use of non-prescribed substances or illicit drugs. It should be employed when there are risk factors or concerns for misuse or diversion, such as a history of substance use disorder, concurrent benzodiazepine use, multiple prescribers, missed appointments, unexplained dose escalations, or other aberrant medication-taking behavior. Because of cost and the potential to undermine trust, testing every visit or only at discharge is not appropriate. Baseline testing and periodic testing when risk factors emerge or concerns arise help balance patient trust with safety.